Appropriately incentivizing surgeons to increase efficiency by delivering higher quality care at a lower cost could significantly improve the value of healthcare delivery in the United States. In this proposal, a private performance feedback report for surgeons performing pediatric adenotonsillectomy (T&A) is tested as a non- financial incentive to improve surgeon and system performance. This report includes postoperative outcomes, perioperative process measures, and costs. A pilot program within the Intermountain Healthcare system, in preparation for this award, has provided surgeons with an initial report allowing each surgeon to compare his or her data to hospital and system averages. Adenotonsillectomy (T&A) is the most common major operation performed in children in the US. However, there remains significant geographic, hospital, and surgeon variation in outcomes and costs for this procedure. Intermountain Healthcare maintains a unique Enterprise Data Warehouse (EDW) that contains administrative, financial (including both costs and charges), and clinical data. Costs are derived from the Standard Cost Master, the hospital's cost-accounting program. This is a transaction-based micro-costing system that identifies and aggregates the variable- and fixed-cost components of patient activities, hospital services, and products according to the date of service. Our previous research has demonstrated variation in T&A costs per surgeon across the Intermountain Healthcare system and found that surgeons with higher costs did not necessarily achieve better outcomes, suggesting that variation in surgeon efficiency and performance exist. A pilot private performance feedback report for surgeons performing pediatric T&A has been introduced to surgeons. This report includes average patient satisfaction scores, frequency of adherence to national guidelines for steroid and antibiotic administration, frequency of postoperative complications, and the mean cost of care per case. This application will use an interrupted time-series analysis to determine the efficacy of quarterly reports given to surgeons in improving outcomes and/or reducing costs. Qualitative analysis using study groups will be performed to better understand from a surgeon's perspective the effectiveness of this report. The ultimate goal of this application is to evaluate the efficacy of a private performance feedback report containing outcomes, clinical process measures, and costs in improving surgeon and system efficiency for pediatric T&A. This study will help us better understand how, why, and under what conditions private reporting improves surgeon performance. Applying this approach to other common pediatric surgical conditions can improve health outcomes and reduce costs across the United States.